Opinion: The unintended consequences of work requirements for Medicaid are dangerous

The Medicaid work requirements proposed in the new federal budget bill would add significant barriers to North Carolinians with difficult-to-manage health conditions.

Rachel Phipps is a Concord resident with Lupus and Multiple Sclerosis, who relies on Medicaid.

North Carolina is at a stark crossroads as Congress contemplates changes to Medicaid that could add significant barriers to individuals like me with unpredictable health conditions.

In order to meet President Trump’s agenda, the US House and Senate have passed separate bills setting stringent Medicaid work requirements, compelling Medicaid recipients to work, volunteer, or study for at least 80 hours each month to maintain their coverage. 

While the intention behind the work requirements may be to encourage self-sufficiency, the reality is that they could lead to significant coverage loss and poorer health outcomes for many North Carolinians.

I have Lupus (SLE) and MS, and, though I strive to work part-time as a substitute teacher and to volunteer to enhance my skillset, my ability to meet the 80-hour monthly requirement is inconsistent at best. On days when my health allows, I am eager to participate; yet, there are instances when my body fails to comply. The inflexible character of the legislation’s work requirements neglects the reality facing people with chronic illnesses.

The House and Senate have each passed competing versions of the budget bill, which include the Medicaid requirements and nearly a trillion dollars in cuts. The changes are not yet law, but the House is preparing to vote any minute  on the final version, and it could soon go to President Trump to sign.

The current version of the bill allows for some exemptions from the requirements, but the criteria is indistinct, and the exemption paperwork is complex, adding another burden just to prove your status. This may jeopardize my healthcare coverage if I fail to meet the requirements and conditions, even though I am already among those eligible for an exemption.

Fatal consequences

The difficulties in other states that already have work requirements suggest I could encounter other obstacles in obtaining essential care, rendering me vulnerable in managing prescriptions and treatments. My health issues bring periods of health that can last several months, but then worsen unexpectedly for long periods of time. If I fail to complete the requirements during flare-ups, I risk losing coverage at times of my greatest need, which could hinder my societal contributions or even be fatal.

I rely heavily on Medicaid for the care that keeps my conditions in check. Without it, the cost of my infusion treatments would be prohibitive.

This is not just a personal concern; it is a public health issue. If individuals like me lose access to necessary medical care, the long-term costs to the healthcare system will far outweigh any short-term savings from reduced Medicaid rollbacks.  Hospitals are projected to incur $83 billion in uncompensated care over the next decade due to losses in Medicaid coverage. The financial load, along with a projected $1 trillion decline in healthcare provider revenue, is expected to lead to elevated pricing for medical services, affecting consumers, employers, and government programs. 

Moreover, the logistical challenges of meeting these requirements are compounded by my lack of reliable transportation, a common problem for many other North Carolinians relying on Medicaid for survival. Public transportation options are limited in most North Carolina rural areas, where employment opportunities and support services are already scarce. Rideshare services like Uber are unaffordable. The new requirements could exacerbate these disparities, leaving rural residents with even fewer resources.

Extra burdens

The administrative burden of implementing these work requirements is another concern. The state will need to allocate significant resources to track compliance, process exemptions, and handle appeals. This could divert funds from other critical areas of the Medicaid program, potentially affecting the quality and accessibility of care for all beneficiaries. The complexity of the reporting process may also lead to administrative errors, resulting in eligible individuals losing coverage because of bureaucratic hurdles rather than any failure to meet work criteria.

The broader economic and health implications of these changes cannot be ignored. The Congressional Budget Office estimates that the proposed modifications in the bill the Senate just passed could lead to a reduction of 11.8 million individuals enrolled in Medicaid by 2034. In North Carolina, this could translate to increased uncompensated care costs for hospitals, particularly in rural areas where financial resources are already strained. The cuts could force some rural hospitals to close, further limiting access to care. To mitigate potential disruptions, Senate Republicans have proposed a hefty $25 billion fund targeted at bolstering rural hospitals, a lifeline to attempt to shield them from the adverse outcomes that these legislative shifts could unleash. However, this is not enough.

North Carolina must consider alternative solutions that support both the health and economic well-being of its residents. Enhancing support services, such as job training programs and transportation assistance, could help individuals meet work requirements while minimizing risk. Simplifying the reporting process and investing in administrative efficiency would also reduce the risk of eligible individuals losing coverage due to bureaucratic obstacles.

As someone who relies on Medicaid to manage my chronic health conditions, I urge House Republicans to reconsider these requirements and prioritize the health and well-being of all residents. The long-term costs of these changes, both human and economic, are simply too high to ignore.